Comparative Results between Conversion to Total Hip Arthroplasty Secondary to Failed Osteosynthesis versus Total Hip Arthroplasty after Femoral Neck Fracture

Comparative Results between Conversion to Total Hip Arthroplasty Secondary to Failed Osteosynthesis versus Total Hip Arthroplasty after Femoral Neck Fracture | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative Results between Conversion to Total Hip Arthroplasty Secondary to Failed Osteosynthesis versus Total Hip Arthroplasty after Femoral Neck Fracture Carlos Martin Lucero, Agustin Martinez Lotti, Agustin Albani Forneris, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8129783/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Conversion to total hip arthroplasty (cTHA) after failed osteosynthesis has been associated with higher complication rates than elective THA, yet comparative evidence in femoral neck fractures (FNF) remains limited. This study compared length of stay (LOS), complication rates, and 90-day unplanned readmissions between patients undergoing cTHA and those treated with primary THA for FNF (pTHA). Methods A retrospective cohort study was performed at a tertiary center between 2015 and 2022. Patients undergoing cTHA after failed osteosynthesis or hybrid pTHA for displaced FNFs were included, with a minimum follow-up of one year. Demographic variables (age, sex, BMI, ASA score, Charlson comorbidity index) and postoperative outcomes were analyzed. Results A total of 106 patients were included: 75 pTHA and 31 cTHA. Mean follow-up was 36.2 months (4–85). Operative time was significantly longer in the cTHA group (94.9 vs. 74.9 minutes, p = 0.002). LOS was similar between groups (6.9 vs. 5.48 days, p = 0.12). Ninety-day complication rates did not differ significantly (32% pTHA vs. 16.1% cTHA, p = 0.14). Unplanned readmissions were also comparable (18.6% vs. 16.1%, p = 0.75). Conclusion Despite longer operative times, cTHA demonstrated similar LOS, complication rates, and 90-day unplanned readmissions compared to pTHA for FNF. These findings suggest that, when appropriately indicated and performed in experienced centers, cTHA is a safe salvage option following failed osteosynthesis. Nevertheless, meticulous preoperative planning remains essential due to the increased complexity of conversion procedures. Total Hip Arthroplasty THA Conversion to Total Hip Arthroplasty Femoral Neck Fracture Complications Failed Osteosynthesis Figures Figure 1 Introduction The treatment of non-displaced femoral neck fractures (Garden I and II) [ 1 ] through osteosynthesis is widely reported in the literature as one of the most effective treatments.[ 2 ] Pertrochanteric fractures are often treated with cephalomedullary nails (CMN) or dynamic hip screws (DHS), while FNFs are typically treated with cannulated screws (CS) or joint replacement depending on the specific fracture pattern and patient characteristics.[ 3 ] With failure rates ranging from 1.2% to 9.6% [ 4 – 7 ], osteosynthesis offers benefits such as preservation of the native joint, lower costs, and shorter operative times [ 2 , 8 – 10 ]; however, it is not without complications such as cut-through, cut-out, hardware failure, and non-union. [ 10 – 12 ]. Time-to-failure is variable though most frequently occurs in the first postoperative year [ 13 – 15 ] When internal fixation fails, re-osteosynthesis may be useful in young patients with high functional demands and optimum bone stock [ 16 ]; conversely, it is not recommended for elderly patients with low functional demands and osteoporosis [ 17 ]. In this latter group, conversion to total hip arthroplasty (cTHA) serves as a salvage procedure for failed osteosynthesis due to hip fractures. Both primary fixation of hip fractures and conversion from failed osteosynthesis are complex surgeries with challenging recoveries that can significantly impact morbidity and mortality associated with hip fractures.[ 13 ] The literature reports higher complication rates in conversions from osteosynthesis to THA compared to elective THAs [ 18 , 19 ]; however, there is limited evidence comparing these two procedures within the context of FNF. This study aimed to compare length of stay, complication rates, and unplanned readmissions at 90 days between patients undergoing conversions to THA due to failed osteosynthesis versus those undergoing THA for FNFs. Our hypothesis is that in the group of conversions to THA, despite undergoing a second surgical intervention in a frail patient, there would be no differences in terms of postoperative evolution and complications with the group of patients with fractures treated with THA. Methods After approval from the Institutional Ethics Committee, we retrospectively analyzed patients who underwent a THA for FNF or a conversion to THA at our institution between February 2015 and December 2022. Patients over 18 years old with past medical history of hip fracture including: intertrochanteric fractures or Garden I/II femoral neck fracture with failed osteosynthesis treated with CS (7), DHS (6), or CMN (18) were included in group cTHA, while pTHA group included community ambulatory patients younger than 90 years with displaced Garden III–IV FNFs treated with hybrid THA. From 582 Garden III/IV FNF performed THA, a sample of 75 patients meeting the inclusion criteria was randomly selected for analysis. (Fig. 1 ) Hemiarthroplasty cases which were performed in older and low/non-ambulatory patients were not included, as well as pathological fractures. Patients under 18 years old, failed osteosynthesis treated with a new osteosynthesis, pTHA patients who had undergone THA for a different diagnosis than FNF, patients who had revision surgeries and incomplete documentation regarding their preoperative status were excluded. Data was extracted from our electronic database established since 2006 and prospectively recorded. Patient Demographics The final cohort consisted of 106 patients meeting inclusion and exclusion criteria mentioned above were divided into two groups: pTHA comprised of 75 patients (70,2%) treated with hybrid THAs secondary to FNF and cTHA comprising 31 patients (29,2%) undergoing conversion from failed osteosynthesis. Demographic data including age, sex, modified Charlson Comorbidity Index categorized into three grades: mild (scores of 1–2), moderate (scores of 3–4), severe (scores of ≥ 5) [ 20 ], and ASA scores classified into two groups: I–II/III–IV were collected. Table 1 ) [ 21 ]. In addition, causes of conversion (cut-through, cut-out, avascular necrosis, hardware failure, non-union, infection, post-traumatic osteoarthritis) and the type of osteosynthesis used in the index surgery were recorded. (Table 2 ) Surgical Protocol All patients received prophylactic antibiotic induction along with three postoperative doses of intravenous Cefazolin (1 gram/8 hours). Routine thromboprophylaxis was administered using subcutaneous Enoxaparin (40 mg/24 hours) or by oral anticoagulants during the first month postoperatively based on thromboembolic risk protocol. [ 22 ] Surgeries were performed in operating rooms with laminar airflow, under hypotensive epidural anesthesia and through a posterolateral approach by four trained hip surgeons. Preoperative template was performed with a calibrated digital imaging system (RAIM VIEWER, ALMA-ORTHO 5.0, Barcelona, ​​Spain). After surgical closure, the approach area was infiltrated with a cocktail of Ropivacaine, Triamcinolone, Morphine, Adrenaline and Tranexamic Acid. The dose was adjusted to the renal function of each patient at the discretion of the anesthesiologist. Clinical Evaluation Length of stay (LOS) and surgical time were recorded along with clinical comorbidities evaluated including hypertension, diabetes mellitus, cardiovascular diseases, respiratory diseases, neurological diseases, smoking history, and oncological diseases. Surgical time was defined as the time between skin insicion to the end of wound closure. All patients underwent thorough preoperative evaluations through an institutional clinical protocol designed specifically for this purpose. The same rehabilitation protocol was performed including early mobilization post-surgery using a walker based on individual case categorization. Subsequently, we encourage patients to progressively resume their daily activities depending on their clinical and radiographic evolution during follow-up. Analysis of Complications Postoperative complications were divided according to whether they occurred during hospitalization or in the first 90 postoperative days and were grouped into major (grades III to V) or minor (grades I and II) as established by the modified Clavien-Dindo classification (C-D) [ 23 ]. A readmission was defined as an episode of re-hospitalization for "any cause" within 90 days of discharge; readmissions occurring later were considered unrelated to care provided during the index admission. Patient survival was assessed up to 2 years of follow-up. Statistical Analysis Continuous variables were expressed as means and ranges according to their distribution while categorical variables were reported as frequencies and percentages. Independent samples T-tests compared continuous variables normally distributed; Mann–Whitney U tests were used otherwise. Categorical variables were compared using chi-square tests for independent samples along with Fisher's exact test when appropriate. Logistic regressions were performed univariately followed by multivariate analysis including variables with p < 0.05 values. Odds ratios (OR) were reported along with a 95% confidence interval. Statistical analysis was conducted using IBM SPSS Statistics for Windows version 26. Results Demographic Variables The mean length of stay (LOS) was 6.9 days (range: 2–75) for the pTHA group while it was 5.4 days (range: 2–20) for the cTHA group without significant differences between both groups (p = 0.12). Surgical time averaged at 74.9 minutes (range: 45–130) for pTHA compared to 94.9 minutes (range:50–180) for cTHA showing significant differences (p = 0.002). The mean follow-up was reported at approximately 36 months (range: 4–85) across both groups. (Table 1 ) Regarding the type of implant, all cases in the pTHA group utilized hybrid implants, while in the cTHA group, there were 4 cemented THAs (12.9%), 15 uncemented THAs (48.3%), 10 hybrid THAs with femoral cement (32.2%), and 2 hybrid THAs with acetabular cement (6.4%). (Table 1 ) Table 1 Demographics of the series divided by groups Variable 1 pTHA (n = 75) 2 cTHA (n = 31) P value Mean age at surgery (range) 79 (54–93) 77 (35–94) 0.46 Female sex § (%) 62 (54) 24 (74.4) 0.63 Mean 3 BMI kg/m2 (SD) 24.8 (4.4) 25.4 (3.3) 0.48 4 ASA score § (%) I II III IV 1 (1.3) 28 (37.3) 46 (61.3) - 2 (6.45) 16 (48.4) 13 (41.9) 1 (3.22) 0.17 5 CCI § (%) Mild Moderate Severe 54 (72) 10 (13.3) 11 (14.6) 25 (80.6) 3 (9.6) 3 (9.6) 0.72 6 Mean LOS (days) 6.9 (2–75) 5.4 (2–20) 0.12 Surgical time (minutes) 74.9 (45–130) 94.9 (50–180) 0.002 Type of THA implant Cemented Uncemented Hybrid Reverse Hybrid - - 75 (100) - 4 (12.9) 15 (48.3) 10 (32.2) 2 (6.4) N/A *Values are expressed as a mean along with the standard deviation in parentheses. § Values are presented as frequency and percentage in parentheses. 1 pTHA: Primary Total Hip Arthroplasty 2 cTHA: Conversion to Total Hip Arthroplasty 3 BMI: Body mass index 4 ASA: American Society of Anesthesia 5 CCI: Charlson Comorbidity Index 6 LOS: Length of stay The implants used during the index surgery included: 18 CMN (58%), 6 DHS (19.3%), and 7 CS (22.5%). The recorded causes of failure were: 9 cut-through (29%), 14 cut-out (45.1%), 9 avascular necrosis (29%), 3 non-union (9.6%), 3 post-traumatic osteoarthritis (9.6%), and 2 hardware failure (6.4%). No cases of peri-implant infection were found. (Table 2 ) Table 2 Primary osteosynthesis following 1PFF and failure causes in cTHA patients Type of primary osteosynthesis pTHA (n = 31 ) 2 CMN 18 (58) 3 DHS 6 (19.3) 4 CS 7 (22.5) Cause of failure Cut Through 9 (29) Avascular Necrosis 9 (29) Non-union 3 (9.6) Infection - Postraumatic osteoarthritis 3 (9.6) Cut out 14 (45.1) Hardware failure 2 (6.4) *Values are presented as the number of patients, and percentage in parentheses. 1 PPF: Proximal Femur Fracture 2 CMN: Cephalomedullary nail 3 DHS: Dynamic Hip Screws 4 CS: Cannulated screws. Analysis of Postoperative Complications Complications were classified based on their timing of occurrence. Intraoperative complications were reported as follows: 2 in the pTHA group (2.6%) and 2 in the cTHA group (6.4%). In both groups, these complications were Vancouver A2 periprosthetic fractures and classified as minor complications (grade II) according to the Clavien-Dindo classification (C-D) (p = 0.57). In-hospital complications totaled 26 for the pTHA group (34.7%) and 4 for the cTHA group (12.9%), showing a significant difference between both groups (p = 0.02). The most frequent complication in both groups was blood transfusion, classified as a minor complication (grade II by C-D). Within the first 90 days postoperatively, a total of 24 complications were reported in the pTHA group (32%) and 5 in the cTHA group (16.1%), with no significant differences between groups (p = 0.14). Events recorded in the pTHA group included: 1 deep infection (1.3%, grade IIIb by C-D), 4 superficial infections (5.3%, grade I by C-D), 2 dislocations (2.6%, grade IIIa by C-D), 1 periprosthetic fracture (1.3%, B2 by Vancouver and IIIb by C-D), 2 deep vein thrombosis (DVT) (2.6%, grade II by C-D), 5 urinary tract infections (UTI) (6.7%, grade II by C-D), 2 pneumonias (2.6%, grade II by C-D) and 7 other minor complications (9.3%). In the cTHA group, complications included: 2 deep infections (6.4%, grade IIIb by C-D), 1 dislocation (3.2%, grade IIIa by C-D) and other minor complications in 3.2% of patients. (Table 3 ) Table 3 Complications and mortality Complication pTHA (n = 75) Clavien- Dindo cTHA (n = 31) Clavien- Dindo P value Intraoperative (%) 1 PPF(A2) 2 (2.6) 3B (major) 2 (6.4) 3B (major) 0.57 In-hospital (%) Transfussions 26 (34.7) 2 (minor) 4 (12.9) 2 (minor) 0.02 90-day postoperative (%) 24 (32) 5 (16.1) 0.14 Deep infection 1 (1.3) 3B (major) 2 (6.4) 3B (major) Superficial infection 4 (5.3) 1 (minor) 0 Dislocation 2 (2.6) 3A (major) 1 (3.2) 3A (major) PPF (B2) 1 (1.3) 3B (major) PPF (C) 0 1 (3.2) 3B (major) 2 DVT 2 (2.6) 2 (minor) 0 3 UTI 5 (6.7) 2 (minor) 0 Pneumonia 2 (2.6) 2 (minor) 0 Other 7 (9.3) 1 (3.2) 90-day readmission 14 (18.6) 5 (16.1) 0.75 90-day reintervention 2 (2.6) 3 (9.6) 0.14 Mortality 6-month 1- year 3 (4) 5 (6.7) 1 (3.2) 1 (3.2) 1 0.66 *Values are presented as the number of patients, and percentage in parentheses. 1 PPF: Periprosthetic fracture 2 DVT: Deep vein thrombosis 3 UTI: Urinary tract infection Readmissions The readmission rate at 90 days was 18.6% for the pTHA group and 16.1% for the cTHA group, with no significant differences between both groups (p = 0.75). The reoperation rate at 90 days was reported as 2.6% for the pTHA group and 9.6% for the cTHA group, again showing no significant differences between groups (p = 0.14). (Table 3 ) Mortality Mortality rates at six months were comparable between both groups, with a rate of 3.2% in the conversion group (cTHA) and a rate of 4% in the hybrid THA group (pTHA), showing no significant differences between them (p = 1). Similarly, one-year mortality rates also showed comparable results, with a rate of 3.2% in the cTHA group and a rate of 6.7% in the pTHA group, again with no statistically significant differences between groups (p = 0.66). (Table 3 ) Logistic Regression Analysis for Complications The multivariate logistic regression analysis is shown in Table 4 . Variables associated with a higher probability of complications at 90 days included being in the cTHA group, ASA score, CCI, female sex, and age. Nonetheless, after adjusting for confounders, conversion to THA lost statistical significance with an odds ratio of 0.3 (95% Confidence Interval [CI] from 0.09 to 1.08, p = 0.06). Table 4 Logistic regression analysis for complications Variable 1 OR 2 SD 3 CI 95% P value cTHA group 0.32 0.20 0.09–1.08 0.06 ASA III 0.99 0.45 0.40–2.43 0.98 CCI severe 0.66 0.45 0.17–2.53 0.55 Female sex 0.44 0.23 0.15–1.2 0.13 Age 1.12 0.04 1.03–1.21 0.004 1 OR: Odds Ratio 2 SD: Standard deviation 3 CI: Confidence interval Discussion This study aimed to compare the length of stay (LOS), complication rates, and unplanned readmissions at 90 days between patients undergoing conversion to total hip arthroplasty (cTHA) due to failed osteosynthesis as well as those undergoing elective THA by femoral neck fractures (pTHA). Conversion to THA, although technically demanding, appears to be a safe and effective salvage strategy when appropriately indicated and performed by experienced surgeons. Nonetheless, this procedure presents significant clinical and surgical challenges, due to the patients' previous history and complications associated with the removal of the original implant and implantation of the prosthesis. Our findings showed no significant differences in terms of age, sex, BMI and comorbidities between both groups, suggesting that the study population is homogeneous and the observed differences in outcomes can be mainly attributed to the type of surgical procedure. The most common type of primary osteosynthesis in our study was the CMN (58%) and the most frequent cause of failure was the cut-out of the blade or screw, representing 45% of the failures, which is in agreement with the findings reported by Magnuson et al. (49%). These results differ from those observed by Van Leent et al., where the most frequently used device was the multiple CS. Regarding postoperative complications, contrary to what the literature reports [ 18 , 19 , 24 ], our study did not find significant differences in the overall incidence of complications between the two groups. Vancouver A2 periprosthetic fractures were the most common intraoperative complications in both groups. The overall incidence of these fractures in the cTHA group was 9.6%, aligning with that reported by Zeng et al. for patients with previous CMN (4.2%). During hospitalization, the most frequent complications in both groups were blood transfusions, aligning with the findings of O'Connor and Zhang. At 90 days postoperatively, general complications were more varied in the pTHA group, with superficial infection standing out in 5.3% of cases, while the cTHA group presented a higher incidence of deep infections (6.4%). The operative time was significantly longer in the cTHA group, which is understandable given the need to remove the original implant and proceed with the THA implantation. Nonetheless, there were no significant differences in readmission rates (p = 0.75) or reintervention rates (p = 0.14) between the two groups at 90 days. Finally, the length of stay (LOS) was comparable between the two groups, with a mean of 6.9 days for the pTHA group and 5.4 days for the cTHA group, with no significant differences (p = 0.12), aligning with the results reported by Lee et al. We acknowledge several limitations. First, the sample size is limited, which may affect the accuracy of the results obtained. A low number of patients increases the likelihood/probability that small differences between groups will not reach statistical significance, which could lead to erroneous conclusions. Second, the relatively short follow-up period, partly influenced by the advanced age of the cohort, may limit the extrapolation of long-term outcomes. Finally, the heterogeneity in the groups could have introduced a bias, since it is possible that patients with better prognosis were included in the conversion to hip arthroplasty, which could explain the results similar to those obtained in FNF arthroplasty. Conclusion This comprehensive analysis demonstrates that while conversion procedures may entail longer operative times they do not significantly differences in terms of hospital stays, unplanned reinterventions or complication rates when compared against elective total hip arthroplasties following femoral neck fractures. Nonetheless, careful planning is essential for conversion cases given the increased demands during surgery, hospital care, and postoperative follow-up Declarations Funding This study did not require any funding to be carried out. As a retrospective study, all data was available in electronic medical records Competing interests The authors declare that they have no competing interests. Ethics approval & Consent This study was approved by the Institutional Ethics Committee. Informed consent was obtained from all individual participants included in the study. Data availability Data was extracted from our electronic database established since 2006 and prospectively recorded. Authors' contributions Author A: Co-designed the study, performed data analysis, and drafted the manuscript. Author B: Assisted with data analysis and manuscript editing. Author C: Conducted data analysis and contributed to manuscript writing. Author D: Co-designed the study and revised the manuscript. Author E: Co-designed the study and reviewed the manuscript. Author F: Assisted with data analysis and manuscript editing. Author G: Managed data entry, assisted with data analysis, and edited the manuscript. Author H : Co-designed the study, led data analysis, and provided critical manuscript revisions. References Garden RS, IN FRACTURES OF THE FEMORAL NECK (1961) LOW-ANGLE FIXATION. J Bone Joint Surg Br. Nov 1;43-B(4):647–63 Dolatowski FC, Frihagen F, Bartels S, Opland V, Šaltytė Benth J, Talsnes O et al (2019) Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in Elderly Patients: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am Jan 16(2):136–144 Bhandari M, Swiontkowski M (2017) Management of Acute Hip Fracture. N Engl J Med. 2017;377(21):2053–62 Lee YK, Kim JT, Alkitaini AA, Kim KC, Ha YC, Koo KH (2017) Conversion Hip Arthroplasty in Failed Fixation of Intertrochanteric Fracture: A Propensity Score Matching Study. J Arthroplasty May 32(5):1593–1598 Pui CM, Bostrom MP, Westrich GH, Della Valle CJ, Macaulay W, Mont MA et al (2013) Increased complication rate following conversion total hip arthroplasty after cephalomedullary fixation for intertrochanteric hip fractures: a multi-center study. J Arthroplasty Sep 28(8 Suppl):45–47 Ovesen O, Andersen M, Poulsen T, Nymark T, Overgaard S, Rock ND (2006) The trochanteric gamma nail versus the dynamic hip screw: a prospective randomised study. One-year follow-up of 146 intertrochanteric fractures. Hip Int Oct-Dec 16(4):293–298 O’Connor CM, Young JR, Villacres Mori B, Murtaza H, Lyons ST, Czajka C et al (2023) Conversion total hip arthroplasty following extracapsular hip fracture fixation with a cephalomedullary device: a comprehensive review. Arch Orthop Trauma Surg Jun 143(6):3525–3533 Valverde JA, Alonso MG, Porro JG, Rueda D, Larrauri PM, Soler JJ (1998) Use of the Gamma nail in the treatment of fractures of the proximal femur. Clin Orthop Relat Res May (350):56–61 Wang Z, Gu F, Xu S, Yue Y, Sun K, Nie W (2022) Intramedullary Nail or Primary Arthroplasty? A System Review and Meta-Analysis on the Prognosis of Intertrochanteric Femoral Fractures Based on Randomized Controlled Trials. Geriatr Orthop Surg Rehabil Aug 6:13:21514593221118212 Chen WH, Guo WX, Gao SH, Wei QS, Li ZQ, He W (2021) Arthroplasty proximal femoral nails for unstable intertrochanteric femoral fractures in elderly patients: A systematic review and meta-analysis. World J Clin Cases Nov 16(32):9878–9888 Aguado-Maestro I, Escudero-Marcos R, García-García JM, Alonso-García N, Pérez-Bermejo DD, Aguado-Hernández HJ et al (2013) [Results and complications of pertrochanteric hip fractures using an intramedullary nail with a helical blade (proximal femoral nail antirotation) in 200 patients]. Rev Esp Cir Ortop Traumatol May 16(3):201–207 Frei HC, Hotz T, Cadosch D, Rudin M, Käch K (2012) Central head perforation, or cut through, caused by the helical blade of the proximal femoral nail antirotation. J Orthop Trauma Aug 26(8):102–107 Magnuson JA, Griffin SA, Hobbs J, D’Amore T, Hughes AJ, Sherman MB et al (2023) Mortality and Complications Following Early Conversion Arthroplasty for Failed Hip Fracture Surgery. J Arthroplasty May 38(5):843–848 Tucker A, Warnock M, McDonald S, Cusick L, Foster AP (2018) Fatigue failure of the cephalomedullary nail: revision options, outcomes and review of the literature. Eur J Orthop Surg Traumatol Apr 28(3):511–520 Lambers A, Rieger B, Kop A, D’Alessandro P, Yates P (2019) Implant Fracture Analysis of the TFNA Proximal Femoral Nail. J Bone Joint Surg Am. May 1;101(9):804–11 Liu P, Jin D, Zhang C, Gao Y (2020) Revision surgery due to failed internal fixation of intertrochanteric femoral fracture: current state-of-the-art. BMC Musculoskelet Disord. Aug 22;21(1):573 Singh S, Rastogi D, Ozair A, Waliullah S, Singh S, Srivastava R (2022) Total hip arthroplasty for failed osteosynthesis of proximal femoral fractures: Clinical outcomes from a low- and middle-income country. J Arthrosc Jt Surg 9(1):22 Zhang B, Chiu KY, Wang M (2004) Hip arthroplasty for failed internal fixation of intertrochanteric fractures. J Arthroplasty Apr 19(3):329–333 van Leent EAP, Schmitz PP, de Jong LD, Zuurmond RG, Vos CJ, van Susante JLC et al (2022) Complications and survival of conversion to total hip arthroplasty after failed primary osteosynthesis compared to primary total hip arthroplasty in femoral neck fractures. Injury Aug 53(8):2853–2858 Li B, Evans D, Faris P, Dean S, Quan H (2008) Risk adjustment performance of Charlson and Elixhauser comorbidities in ICD-9 and ICD-10 administrative databases [Internet]. Vol. 8, BMC Health Services Research. Available from: http://dx.doi.org/10.1186/1472-6963-8-12 Sankar A, Johnson SR, Beattie WS, Tait G, Wijeysundera DN (2014) Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth Sep 113(3):424–432 Salvati EA, Sharrock NE, Westrich G, Potter HG, Valle AGD, Sculco TP (2007) The 2007 ABJS Nicolas Andry Award: Three Decades of Clinical, Basic, and Applied Research on Thromboembolic Disease after THA: Rationale and Clinical Results of a Multimodal Prophylaxis Protocol. Clin Orthop Relat Res Jun 459:246 Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg Aug 250(2):187–196 Schwarzkopf R, Baghoolizadeh M (2015) Conversion total hip arthroplasty: Primary or revision total hip arthroplasty. World J Orthop Nov 18(10):750–753 Zeng X, Zhan K, Zhang L, Zeng D, Yu W, Zhang X et al (2017) Conversion to total hip arthroplasty after failed proximal femoral nail antirotations or dynamic hip screw fixations for stable intertrochanteric femur fractures: a retrospective study with a minimum follow-up of 3 years. BMC Musculoskelet Disord Jan 25(1):38 Petrie J, Sassoon A, Haidukewych GJ (2013) When femoral fracture fixation fails: salvage options. Bone Joint J. Nov;95-B(11 Suppl A):7–10 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8129783","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":556176044,"identity":"8ae9f263-a2c3-4f13-b374-18f7c39fa9e8","order_by":0,"name":"Carlos Martin 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Aires","correspondingAuthor":false,"prefix":"","firstName":"Agustin","middleName":"Martinez","lastName":"Lotti","suffix":""},{"id":556176046,"identity":"327eb922-08c1-4920-9304-cd5c51aa013f","order_by":2,"name":"Agustin Albani Forneris","email":"","orcid":"","institution":"Hospital Italiano de Buenos Aires","correspondingAuthor":false,"prefix":"","firstName":"Agustin","middleName":"Albani","lastName":"Forneris","suffix":""},{"id":556176047,"identity":"8957feaa-79ec-4cd8-8d7b-88922f976f3d","order_by":3,"name":"Luis Camacho Terceros","email":"","orcid":"","institution":"Hospital Italiano de Buenos Aires","correspondingAuthor":false,"prefix":"","firstName":"Luis","middleName":"Camacho","lastName":"Terceros","suffix":""},{"id":556176048,"identity":"0e066ea7-ce7f-4968-b3e6-8b30621fe5e5","order_by":4,"name":"Pablo Ariel Isidoro Slullitel","email":"","orcid":"","institution":"Hospital Italiano de Buenos Aires","correspondingAuthor":false,"prefix":"","firstName":"Pablo","middleName":"Ariel Isidoro","lastName":"Slullitel","suffix":""},{"id":556176049,"identity":"3b1df199-a42b-4d08-b65f-2176a4567e07","order_by":5,"name":"Gerardo Zanotti","email":"","orcid":"","institution":"Hospital Italiano de Buenos Aires","correspondingAuthor":false,"prefix":"","firstName":"Gerardo","middleName":"","lastName":"Zanotti","suffix":""},{"id":556176050,"identity":"72cd5bfa-2e42-4cbd-bd19-9b099b9c8c0f","order_by":6,"name":"Fernando Martin Comba","email":"","orcid":"","institution":"Hospital Italiano de Buenos Aires","correspondingAuthor":false,"prefix":"","firstName":"Fernando","middleName":"Martin","lastName":"Comba","suffix":""},{"id":556176051,"identity":"5a6c8e05-c17c-4660-a904-e54749e3af9c","order_by":7,"name":"Martin Alejandro Buttaro","email":"","orcid":"","institution":"Hospital Italiano de Buenos Aires","correspondingAuthor":false,"prefix":"","firstName":"Martin","middleName":"Alejandro","lastName":"Buttaro","suffix":""}],"badges":[],"createdAt":"2025-11-16 23:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8129783/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8129783/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":97701904,"identity":"cd70e1b6-3d16-4124-9245-9f09ae7ad4cb","added_by":"auto","created_at":"2025-12-08 12:27:12","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5133747,"visible":true,"origin":"","legend":"","description":"","filename":"CorrectedManuscriptCLwithtables161125copyEJOST.docx","url":"https://assets-eu.researchsquare.com/files/rs-8129783/v1/c6d6e766305e8209c6f69b5a.docx"},{"id":97701902,"identity":"64ce3f39-dc32-4dcc-8ae2-51b95c8db9da","added_by":"auto","created_at":"2025-12-08 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12:27:12","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":81336,"visible":true,"origin":"","legend":"","description":"","filename":"79a1e89418434084bb3dba4c7438a1091structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8129783/v1/460b13e057a6c4b62df5b64c.xml"},{"id":97701905,"identity":"ec9bb0b7-d81b-4584-9098-c309741d48fd","added_by":"auto","created_at":"2025-12-08 12:27:12","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":88813,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8129783/v1/405b1779beafc767f5e13d06.html"},{"id":97701898,"identity":"faf43532-d112-4cf4-ad16-a10c6c534df1","added_by":"auto","created_at":"2025-12-08 12:27:12","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":97824,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eFlowchart demonstrating patients’ enrolment\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8129783/v1/e524e19971358e03b1700808.jpg"},{"id":99983780,"identity":"b23633ff-9080-4702-be98-98e992eaaad3","added_by":"auto","created_at":"2026-01-11 16:53:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":944815,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8129783/v1/ac8df2ac-7590-4213-9a22-685d6cef9889.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Results between Conversion to Total Hip Arthroplasty Secondary to Failed Osteosynthesis versus Total Hip Arthroplasty after Femoral Neck Fracture","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe treatment of non-displaced femoral neck fractures (Garden I and II) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] through osteosynthesis is widely reported in the literature as one of the most effective treatments.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Pertrochanteric fractures are often treated with cephalomedullary nails (CMN) or dynamic hip screws (DHS), while FNFs are typically treated with cannulated screws (CS) or joint replacement depending on the specific fracture pattern and patient characteristics.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eWith failure rates ranging from 1.2% to 9.6% [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], osteosynthesis offers benefits such as preservation of the native joint, lower costs, and shorter operative times [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]; however, it is not without complications such as cut-through, cut-out, hardware failure, and non-union. [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Time-to-failure is variable though most frequently occurs in the first postoperative year [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eWhen internal fixation fails, re-osteosynthesis may be useful in young patients with high functional demands and optimum bone stock [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]; conversely, it is not recommended for elderly patients with low functional demands and osteoporosis [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In this latter group, conversion to total hip arthroplasty (cTHA) serves as a salvage procedure for failed osteosynthesis due to hip fractures. Both primary fixation of hip fractures and conversion from failed osteosynthesis are complex surgeries with challenging recoveries that can significantly impact morbidity and mortality associated with hip fractures.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThe literature reports higher complication rates in conversions from osteosynthesis to THA compared to elective THAs [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]; however, there is limited evidence comparing these two procedures within the context of FNF. This study aimed to compare length of stay, complication rates, and unplanned readmissions at 90 days between patients undergoing conversions to THA due to failed osteosynthesis versus those undergoing THA for FNFs. Our hypothesis is that in the group of conversions to THA, despite undergoing a second surgical intervention in a frail patient, there would be no differences in terms of postoperative evolution and complications with the group of patients with fractures treated with THA.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e After approval from the Institutional Ethics Committee, we retrospectively analyzed patients who underwent a THA for FNF or a conversion to THA at our institution between February 2015 and December 2022. Patients over 18 years old with past medical history of hip fracture including: intertrochanteric fractures or Garden I/II femoral neck fracture with failed osteosynthesis treated with CS (7), DHS (6), or CMN (18) were included in group cTHA, while pTHA group included community ambulatory patients younger than 90 years with displaced Garden III\u0026ndash;IV FNFs treated with hybrid THA. From 582 Garden III/IV FNF performed THA, a sample of 75 patients meeting the inclusion criteria was randomly selected for analysis. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) Hemiarthroplasty cases which were performed in older and low/non-ambulatory patients were not included, as well as pathological fractures. Patients under 18 years old, failed osteosynthesis treated with a new osteosynthesis, pTHA patients who had undergone THA for a different diagnosis than FNF, patients who had revision surgeries and incomplete documentation regarding their preoperative status were excluded. Data was extracted from our electronic database established since 2006 and prospectively recorded.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatient Demographics\u003c/h2\u003e\u003cp\u003e The final cohort consisted of 106 patients meeting inclusion and exclusion criteria mentioned above were divided into two groups: pTHA comprised of 75 patients (70,2%) treated with hybrid THAs secondary to FNF and cTHA comprising 31 patients (29,2%) undergoing conversion from failed osteosynthesis. Demographic data including age, sex, modified Charlson Comorbidity Index categorized into three grades: mild (scores of 1\u0026ndash;2), moderate (scores of 3\u0026ndash;4), severe (scores of \u0026ge;\u0026thinsp;5) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and ASA scores classified into two groups: I\u0026ndash;II/III\u0026ndash;IV were collected. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In addition, causes of conversion (cut-through, cut-out, avascular necrosis, hardware failure, non-union, infection, post-traumatic osteoarthritis) and the type of osteosynthesis used in the index surgery were recorded. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSurgical Protocol\u003c/h3\u003e\u003cp\u003eAll patients received prophylactic antibiotic induction along with three postoperative doses of intravenous Cefazolin (1 gram/8 hours). Routine thromboprophylaxis was administered using subcutaneous Enoxaparin (40 mg/24 hours) or by oral anticoagulants during the first month postoperatively based on thromboembolic risk protocol. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eSurgeries were performed in operating rooms with laminar airflow, under hypotensive epidural anesthesia and through a posterolateral approach by four trained hip surgeons. Preoperative template was performed with a calibrated digital imaging system (RAIM VIEWER, ALMA-ORTHO 5.0, Barcelona, ​​Spain). After surgical closure, the approach area was infiltrated with a cocktail of Ropivacaine, Triamcinolone, Morphine, Adrenaline and Tranexamic Acid. The dose was adjusted to the renal function of each patient at the discretion of the anesthesiologist.\u003c/p\u003e\n\u003ch3\u003eClinical Evaluation\u003c/h3\u003e\n\u003cp\u003eLength of stay (LOS) and surgical time were recorded along with clinical comorbidities evaluated including hypertension, diabetes mellitus, cardiovascular diseases, respiratory diseases, neurological diseases, smoking history, and oncological diseases. Surgical time was defined as the time between skin insicion to the end of wound closure.\u003c/p\u003e\u003cp\u003eAll patients underwent thorough preoperative evaluations through an institutional clinical protocol designed specifically for this purpose. The same rehabilitation protocol was performed including early mobilization post-surgery using a walker based on individual case categorization. Subsequently, we encourage patients to progressively resume their daily activities depending on their clinical and radiographic evolution during follow-up.\u003c/p\u003e\n\u003ch3\u003eAnalysis of Complications\u003c/h3\u003e\n\u003cp\u003ePostoperative complications were divided according to whether they occurred during hospitalization or in the first 90 postoperative days and were grouped into major (grades III to V) or minor (grades I and II) as established by the modified Clavien-Dindo classification (C-D) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. A readmission was defined as an episode of re-hospitalization for \"any cause\" within 90 days of discharge; readmissions occurring later were considered unrelated to care provided during the index admission. Patient survival was assessed up to 2 years of follow-up.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eContinuous variables were expressed as means and ranges according to their distribution while categorical variables were reported as frequencies and percentages. Independent samples T-tests compared continuous variables normally distributed; Mann\u0026ndash;Whitney U tests were used otherwise. Categorical variables were compared using chi-square tests for independent samples along with Fisher's exact test when appropriate. Logistic regressions were performed univariately followed by multivariate analysis including variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 values. Odds ratios (OR) were reported along with a 95% confidence interval. Statistical analysis was conducted using IBM SPSS Statistics for Windows version 26.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eDemographic Variables\u003c/h2\u003e\u003cp\u003eThe mean length of stay (LOS) was 6.9 days (range: 2\u0026ndash;75) for the pTHA group while it was 5.4 days (range: 2\u0026ndash;20) for the cTHA group without significant differences between both groups (p\u0026thinsp;=\u0026thinsp;0.12). Surgical time averaged at 74.9 minutes (range: 45\u0026ndash;130) for pTHA compared to 94.9 minutes (range:50\u0026ndash;180) for cTHA showing significant differences (p\u0026thinsp;=\u0026thinsp;0.002). The mean follow-up was reported at approximately 36 months (range: 4\u0026ndash;85) across both groups. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eRegarding the type of implant, all cases in the pTHA group utilized hybrid implants, while in the cTHA group, there were 4 cemented THAs (12.9%), 15 uncemented THAs (48.3%), 10 hybrid THAs with femoral cement (32.2%), and 2 hybrid THAs with acetabular cement (6.4%). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographics of the series divided by groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e pTHA (n\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e cTHA (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean age at surgery (range)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79 (54\u0026ndash;93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77 (35\u0026ndash;94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFemale sex \u0026sect; (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 (54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (74.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean\u003c/b\u003e \u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e \u003cb\u003eBMI kg/m2 (SD)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.8 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.4 (3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003csup\u003e\u003cb\u003e4\u003c/b\u003e\u003c/sup\u003e \u003cb\u003eASA score \u0026sect; (%)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eI\u003c/p\u003e\u003cp\u003eII\u003c/p\u003e\u003cp\u003eIII\u003c/p\u003e\u003cp\u003eIV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003e1 (1.3)\u003c/p\u003e\u003cp\u003e28 (37.3)\u003c/p\u003e\u003cp\u003e46 (61.3)\u003c/p\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003e2 (6.45)\u003c/p\u003e\u003cp\u003e16 (48.4)\u003c/p\u003e\u003cp\u003e13 (41.9)\u003c/p\u003e\u003cp\u003e1 (3.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003csup\u003e\u003cb\u003e5\u003c/b\u003e\u003c/sup\u003e \u003cb\u003eCCI \u0026sect; (%)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMild\u003c/p\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003e54 (72)\u003c/p\u003e\u003cp\u003e10 (13.3)\u003c/p\u003e\u003cp\u003e11 (14.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003e25 (80.6)\u003c/p\u003e\u003cp\u003e3 (9.6)\u003c/p\u003e\u003cp\u003e3 (9.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003csup\u003e\u003cb\u003e6\u003c/b\u003e\u003c/sup\u003e \u003cb\u003eMean\u003c/b\u003e \u003cb\u003eLOS (days)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.9 (2\u0026ndash;75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.4 (2\u0026ndash;20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSurgical time (minutes)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74.9 (45\u0026ndash;130)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94.9 (50\u0026ndash;180)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eType of THA implant\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCemented\u003c/p\u003e\u003cp\u003eUncemented\u003c/p\u003e\u003cp\u003eHybrid\u003c/p\u003e\u003cp\u003eReverse Hybrid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003e-\u003c/p\u003e\u003cp\u003e-\u003c/p\u003e\u003cp\u003e75 (100)\u003c/p\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003e4 (12.9)\u003c/p\u003e\u003cp\u003e15 (48.3)\u003c/p\u003e\u003cp\u003e10 (32.2)\u003c/p\u003e\u003cp\u003e2 (6.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e*Values are expressed as a mean along with the standard deviation in parentheses. \u0026sect; Values\u003c/p\u003e\u003cp\u003eare presented as frequency and percentage in parentheses.\u003c/p\u003e\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e pTHA: Primary Total Hip Arthroplasty\u003c/p\u003e\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e cTHA: Conversion to Total Hip Arthroplasty\u003c/p\u003e\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e BMI: Body mass index\u003c/p\u003e\u003cp\u003e\u003csup\u003e4\u003c/sup\u003e ASA: American Society of Anesthesia\u003c/p\u003e\u003cp\u003e\u003csup\u003e5\u003c/sup\u003e CCI: Charlson Comorbidity Index\u003c/p\u003e\u003cp\u003e\u003csup\u003e6\u003c/sup\u003e LOS: Length of stay\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eThe implants used during the index surgery included: 18 CMN (58%), 6 DHS (19.3%), and 7 CS (22.5%). The recorded causes of failure were: 9 cut-through (29%), 14 cut-out (45.1%), 9 avascular necrosis (29%), 3 non-union (9.6%), 3 post-traumatic osteoarthritis (9.6%), and 2 hardware failure (6.4%). No cases of peri-implant infection were found. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrimary osteosynthesis following 1PFF and failure causes in cTHA patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of primary osteosynthesis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003epTHA (n\u0026thinsp;=\u0026thinsp;31 )\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e CMN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (58)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e DHS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (19.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003csup\u003e4\u003c/sup\u003e CS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (22.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCause of failure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCut Through\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (29)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAvascular Necrosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (29)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-union\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (9.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostraumatic osteoarthritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (9.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCut out\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (45.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHardware failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (6.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e*Values are presented as the number of patients, and percentage in parentheses.\u003c/p\u003e\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e PPF: Proximal Femur Fracture\u003c/p\u003e\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e CMN: Cephalomedullary nail\u003c/p\u003e\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e DHS: Dynamic Hip Screws\u003c/p\u003e\u003cp\u003e\u003csup\u003e4\u003c/sup\u003e CS: Cannulated screws.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAnalysis of Postoperative Complications\u003c/h3\u003e\n\u003cp\u003eComplications were classified based on their timing of occurrence. Intraoperative complications were reported as follows: 2 in the pTHA group (2.6%) and 2 in the cTHA group (6.4%). In both groups, these complications were Vancouver A2 periprosthetic fractures and classified as minor complications (grade II) according to the Clavien-Dindo classification (C-D) (p\u0026thinsp;=\u0026thinsp;0.57).\u003c/p\u003e\u003cp\u003eIn-hospital complications totaled 26 for the pTHA group (34.7%) and 4 for the cTHA group (12.9%), showing a significant difference between both groups (p\u0026thinsp;=\u0026thinsp;0.02). The most frequent complication in both groups was blood transfusion, classified as a minor complication (grade II by C-D).\u003c/p\u003e\u003cp\u003eWithin the first 90 days postoperatively, a total of 24 complications were reported in the pTHA group (32%) and 5 in the cTHA group (16.1%), with no significant differences between groups (p\u0026thinsp;=\u0026thinsp;0.14). Events recorded in the pTHA group included: 1 deep infection (1.3%, grade IIIb by C-D), 4 superficial infections (5.3%, grade I by C-D), 2 dislocations (2.6%, grade IIIa by C-D), 1 periprosthetic fracture (1.3%, B2 by Vancouver and IIIb by C-D), 2 deep vein thrombosis (DVT) (2.6%, grade II by C-D), 5 urinary tract infections (UTI) (6.7%, grade II by C-D), 2 pneumonias (2.6%, grade II by C-D) and 7 other minor complications (9.3%). In the cTHA group, complications included: 2 deep infections (6.4%, grade IIIb by C-D), 1 dislocation (3.2%, grade IIIa by C-D) and other minor complications in 3.2% of patients. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComplications and mortality\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplication\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003epTHA\u0026nbsp; (n\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClavien- Dindo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ecTHA\u0026nbsp; (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eClavien- Dindo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntraoperative (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e PPF(A2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3B (major)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (6.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3B (major)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIn-hospital (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransfussions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (34.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (minor)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (12.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (minor)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e90-day postoperative (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (16.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeep infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3B (major)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (6.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3B (major)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuperficial infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (5.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (minor)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDislocation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3A (major)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3A (major)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePPF (B2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3B (major)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePPF (C)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3B (major)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e DVT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (minor)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e UTI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (minor)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePneumonia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (minor)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (9.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e90-day readmission\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (18.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (16.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e90-day reintervention\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (9.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMortality\u003c/b\u003e\u003c/p\u003e\u003cp\u003e6-month\u003c/p\u003e\u003cp\u003e1- year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (4)\u003c/p\u003e\u003cp\u003e5 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (3.2)\u003c/p\u003e\u003cp\u003e1 (3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e*Values are presented as the number of patients, and percentage in parentheses.\u003c/p\u003e\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e PPF: Periprosthetic fracture\u003c/p\u003e\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e DVT: Deep vein thrombosis\u003c/p\u003e\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e UTI: Urinary tract infection\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eReadmissions\u003c/h2\u003e\u003cp\u003eThe readmission rate at 90 days was 18.6% for the pTHA group and 16.1% for the cTHA group, with no significant differences between both groups (p\u0026thinsp;=\u0026thinsp;0.75). The reoperation rate at 90 days was reported as 2.6% for the pTHA group and 9.6% for the cTHA group, again showing no significant differences between groups (p\u0026thinsp;=\u0026thinsp;0.14). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eMortality\u003c/h2\u003e\u003cp\u003eMortality rates at six months were comparable between both groups, with a rate of 3.2% in the conversion group (cTHA) and a rate of 4% in the hybrid THA group (pTHA), showing no significant differences between them (p\u0026thinsp;=\u0026thinsp;1). Similarly, one-year mortality rates also showed comparable results, with a rate of 3.2% in the cTHA group and a rate of 6.7% in the pTHA group, again with no statistically significant differences between groups (p\u0026thinsp;=\u0026thinsp;0.66). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eLogistic Regression Analysis for Complications\u003c/h2\u003e\u003cp\u003eThe multivariate logistic regression analysis is shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Variables associated with a higher probability of complications at 90 days included being in the cTHA group, ASA score, CCI, female sex, and age. Nonetheless, after adjusting for confounders, conversion to THA lost statistical significance with an odds ratio of 0.3 (95% Confidence Interval [CI] from 0.09 to 1.08, p\u0026thinsp;=\u0026thinsp;0.06).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLogistic regression analysis for complications\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eCI 95%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ecTHA group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.09\u0026ndash;1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eASA III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.40\u0026ndash;2.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCI severe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.17\u0026ndash;2.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale sex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.15\u0026ndash;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.03\u0026ndash;1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e OR: Odds Ratio\u003c/p\u003e\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e SD: Standard deviation\u003c/p\u003e\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e CI: Confidence interval\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to compare the length of stay (LOS), complication rates, and unplanned readmissions at 90 days between patients undergoing conversion to total hip arthroplasty (cTHA) due to failed osteosynthesis as well as those undergoing elective THA by femoral neck fractures (pTHA). Conversion to THA, although technically demanding, appears to be a safe and effective salvage strategy when appropriately indicated and performed by experienced surgeons.\u003c/p\u003e\u003cp\u003eNonetheless, this procedure presents significant clinical and surgical challenges, due to the patients' previous history and complications associated with the removal of the original implant and implantation of the prosthesis. Our findings showed no significant differences in terms of age, sex, BMI and comorbidities between both groups, suggesting that the study population is homogeneous and the observed differences in outcomes can be mainly attributed to the type of surgical procedure.\u003c/p\u003e\u003cp\u003eThe most common type of primary osteosynthesis in our study was the CMN (58%) and the most frequent cause of failure was the cut-out of the blade or screw, representing 45% of the failures, which is in agreement with the findings reported by Magnuson et al. (49%). These results differ from those observed by Van Leent et al., where the most frequently used device was the multiple CS.\u003c/p\u003e\u003cp\u003eRegarding postoperative complications, contrary to what the literature reports [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], our study did not find significant differences in the overall incidence of complications between the two groups. Vancouver A2 periprosthetic fractures were the most common intraoperative complications in both groups. The overall incidence of these fractures in the cTHA group was 9.6%, aligning with that reported by Zeng et al. for patients with previous CMN (4.2%). During hospitalization, the most frequent complications in both groups were blood transfusions, aligning with the findings of O'Connor and Zhang.\u003c/p\u003e\u003cp\u003eAt 90 days postoperatively, general complications were more varied in the pTHA group, with superficial infection standing out in 5.3% of cases, while the cTHA group presented a higher incidence of deep infections (6.4%).\u003c/p\u003e\u003cp\u003eThe operative time was significantly longer in the cTHA group, which is understandable given the need to remove the original implant and proceed with the THA implantation. Nonetheless, there were no significant differences in readmission rates (p\u0026thinsp;=\u0026thinsp;0.75) or reintervention rates (p\u0026thinsp;=\u0026thinsp;0.14) between the two groups at 90 days. Finally, the length of stay (LOS) was comparable between the two groups, with a mean of 6.9 days for the pTHA group and 5.4 days for the cTHA group, with no significant differences (p\u0026thinsp;=\u0026thinsp;0.12), aligning with the results reported by Lee et al.\u003c/p\u003e\u003cp\u003eWe acknowledge several limitations. First, the sample size is limited, which may affect the accuracy of the results obtained. A low number of patients increases the likelihood/probability that small differences between groups will not reach statistical significance, which could lead to erroneous conclusions. Second, the relatively short follow-up period, partly influenced by the advanced age of the cohort, may limit the extrapolation of long-term outcomes. Finally, the heterogeneity in the groups could have introduced a bias, since it is possible that patients with better prognosis were included in the conversion to hip arthroplasty, which could explain the results similar to those obtained in FNF arthroplasty.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis comprehensive analysis demonstrates that while conversion procedures may entail longer operative times they do not significantly differences in terms of hospital stays, unplanned reinterventions or complication rates when compared against elective total hip arthroplasties following femoral neck fractures. Nonetheless, careful planning is essential for conversion cases given the increased demands during surgery, hospital care, and postoperative follow-up\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not require any funding to be carried out. As a retrospective study, all data was available in electronic medical records\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics approval \u0026amp; Consent\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Ethics Committee. Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData availability\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData was extracted from our electronic database established since 2006 and prospectively recorded.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAuthor A: Co-designed the study, performed data analysis, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eAuthor B: Assisted with data analysis and manuscript editing.\u003c/p\u003e\n\u003cp\u003eAuthor C: Conducted data analysis and contributed to manuscript writing.\u003c/p\u003e\n\u003cp\u003eAuthor D: Co-designed the study and revised the manuscript.\u003c/p\u003e\n\u003cp\u003eAuthor E: Co-designed the study and reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eAuthor F: Assisted with data analysis and manuscript editing.\u003c/p\u003e\n\u003cp\u003eAuthor G: Managed data entry, assisted with data analysis, and edited the manuscript.\u003c/p\u003e\n\u003cp\u003eAuthor H : Co-designed the study, led data analysis, and provided critical manuscript revisions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGarden RS, IN FRACTURES OF THE FEMORAL NECK (1961) LOW-ANGLE FIXATION. J Bone Joint Surg Br. Nov 1;43-B(4):647\u0026ndash;63\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDolatowski FC, Frihagen F, Bartels S, Opland V, Šaltytė Benth J, Talsnes O et al (2019) Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in Elderly Patients: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am Jan 16(2):136\u0026ndash;144\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBhandari M, Swiontkowski M (2017) Management of Acute Hip Fracture. N Engl J Med. 2017;377(21):2053\u0026ndash;62\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee YK, Kim JT, Alkitaini AA, Kim KC, Ha YC, Koo KH (2017) Conversion Hip Arthroplasty in Failed Fixation of Intertrochanteric Fracture: A Propensity Score Matching Study. J Arthroplasty May 32(5):1593\u0026ndash;1598\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePui CM, Bostrom MP, Westrich GH, Della Valle CJ, Macaulay W, Mont MA et al (2013) Increased complication rate following conversion total hip arthroplasty after cephalomedullary fixation for intertrochanteric hip fractures: a multi-center study. J Arthroplasty Sep 28(8 Suppl):45\u0026ndash;47\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOvesen O, Andersen M, Poulsen T, Nymark T, Overgaard S, Rock ND (2006) The trochanteric gamma nail versus the dynamic hip screw: a prospective randomised study. One-year follow-up of 146 intertrochanteric fractures. Hip Int Oct-Dec 16(4):293\u0026ndash;298\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eO\u0026rsquo;Connor CM, Young JR, Villacres Mori B, Murtaza H, Lyons ST, Czajka C et al (2023) Conversion total hip arthroplasty following extracapsular hip fracture fixation with a cephalomedullary device: a comprehensive review. Arch Orthop Trauma Surg Jun 143(6):3525\u0026ndash;3533\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eValverde JA, Alonso MG, Porro JG, Rueda D, Larrauri PM, Soler JJ (1998) Use of the Gamma nail in the treatment of fractures of the proximal femur. Clin Orthop Relat Res May (350):56\u0026ndash;61\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang Z, Gu F, Xu S, Yue Y, Sun K, Nie W (2022) Intramedullary Nail or Primary Arthroplasty? A System Review and Meta-Analysis on the Prognosis of Intertrochanteric Femoral Fractures Based on Randomized Controlled Trials. Geriatr Orthop Surg Rehabil Aug 6:13:21514593221118212\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen WH, Guo WX, Gao SH, Wei QS, Li ZQ, He W (2021) Arthroplasty proximal femoral nails for unstable intertrochanteric femoral fractures in elderly patients: A systematic review and meta-analysis. World J Clin Cases Nov 16(32):9878\u0026ndash;9888\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAguado-Maestro I, Escudero-Marcos R, Garc\u0026iacute;a-Garc\u0026iacute;a JM, Alonso-Garc\u0026iacute;a N, P\u0026eacute;rez-Bermejo DD, Aguado-Hern\u0026aacute;ndez HJ et al (2013) [Results and complications of pertrochanteric hip fractures using an intramedullary nail with a helical blade (proximal femoral nail antirotation) in 200 patients]. Rev Esp Cir Ortop Traumatol May 16(3):201\u0026ndash;207\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFrei HC, Hotz T, Cadosch D, Rudin M, K\u0026auml;ch K (2012) Central head perforation, or cut through, caused by the helical blade of the proximal femoral nail antirotation. J Orthop Trauma Aug 26(8):102\u0026ndash;107\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMagnuson JA, Griffin SA, Hobbs J, D\u0026rsquo;Amore T, Hughes AJ, Sherman MB et al (2023) Mortality and Complications Following Early Conversion Arthroplasty for Failed Hip Fracture Surgery. J Arthroplasty May 38(5):843\u0026ndash;848\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTucker A, Warnock M, McDonald S, Cusick L, Foster AP (2018) Fatigue failure of the cephalomedullary nail: revision options, outcomes and review of the literature. Eur J Orthop Surg Traumatol Apr 28(3):511\u0026ndash;520\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLambers A, Rieger B, Kop A, D\u0026rsquo;Alessandro P, Yates P (2019) Implant Fracture Analysis of the TFNA Proximal Femoral Nail. J Bone Joint Surg Am. May 1;101(9):804\u0026ndash;11\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu P, Jin D, Zhang C, Gao Y (2020) Revision surgery due to failed internal fixation of intertrochanteric femoral fracture: current state-of-the-art. BMC Musculoskelet Disord. Aug 22;21(1):573\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh S, Rastogi D, Ozair A, Waliullah S, Singh S, Srivastava R (2022) Total hip arthroplasty for failed osteosynthesis of proximal femoral fractures: Clinical outcomes from a low- and middle-income country. J Arthrosc Jt Surg 9(1):22\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang B, Chiu KY, Wang M (2004) Hip arthroplasty for failed internal fixation of intertrochanteric fractures. J Arthroplasty Apr 19(3):329\u0026ndash;333\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evan Leent EAP, Schmitz PP, de Jong LD, Zuurmond RG, Vos CJ, van Susante JLC et al (2022) Complications and survival of conversion to total hip arthroplasty after failed primary osteosynthesis compared to primary total hip arthroplasty in femoral neck fractures. Injury Aug 53(8):2853\u0026ndash;2858\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi B, Evans D, Faris P, Dean S, Quan H (2008) Risk adjustment performance of Charlson and Elixhauser comorbidities in ICD-9 and ICD-10 administrative databases [Internet]. Vol. 8, BMC Health Services Research. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1186/1472-6963-8-12\u003c/span\u003e\u003cspan address=\"10.1186/1472-6963-8-12\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSankar A, Johnson SR, Beattie WS, Tait G, Wijeysundera DN (2014) Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth Sep 113(3):424\u0026ndash;432\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSalvati EA, Sharrock NE, Westrich G, Potter HG, Valle AGD, Sculco TP (2007) The 2007 ABJS Nicolas Andry Award: Three Decades of Clinical, Basic, and Applied Research on Thromboembolic Disease after THA: Rationale and Clinical Results of a Multimodal Prophylaxis Protocol. Clin Orthop Relat Res Jun 459:246\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eClavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg Aug 250(2):187\u0026ndash;196\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchwarzkopf R, Baghoolizadeh M (2015) Conversion total hip arthroplasty: Primary or revision total hip arthroplasty. World J Orthop Nov 18(10):750\u0026ndash;753\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZeng X, Zhan K, Zhang L, Zeng D, Yu W, Zhang X et al (2017) Conversion to total hip arthroplasty after failed proximal femoral nail antirotations or dynamic hip screw fixations for stable intertrochanteric femur fractures: a retrospective study with a minimum follow-up of 3 years. BMC Musculoskelet Disord Jan 25(1):38\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePetrie J, Sassoon A, Haidukewych GJ (2013) When femoral fracture fixation fails: salvage options. Bone Joint J. Nov;95-B(11 Suppl A):7\u0026ndash;10\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Total Hip Arthroplasty, THA, Conversion to Total Hip Arthroplasty, Femoral Neck Fracture, Complications, Failed Osteosynthesis","lastPublishedDoi":"10.21203/rs.3.rs-8129783/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8129783/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eConversion to total hip arthroplasty (cTHA) after failed osteosynthesis has been associated with higher complication rates than elective THA, yet comparative evidence in femoral neck fractures (FNF) remains limited. This study compared length of stay (LOS), complication rates, and 90-day unplanned readmissions between patients undergoing cTHA and those treated with primary THA for FNF (pTHA).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective cohort study was performed at a tertiary center between 2015 and 2022. Patients undergoing cTHA after failed osteosynthesis or hybrid pTHA for displaced FNFs were included, with a minimum follow-up of one year. Demographic variables (age, sex, BMI, ASA score, Charlson comorbidity index) and postoperative outcomes were analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 106 patients were included: 75 pTHA and 31 cTHA. Mean follow-up was 36.2 months (4\u0026ndash;85). Operative time was significantly longer in the cTHA group (94.9 vs. 74.9 minutes, p\u0026thinsp;=\u0026thinsp;0.002). LOS was similar between groups (6.9 vs. 5.48 days, p\u0026thinsp;=\u0026thinsp;0.12). Ninety-day complication rates did not differ significantly (32% pTHA vs. 16.1% cTHA, p\u0026thinsp;=\u0026thinsp;0.14). Unplanned readmissions were also comparable (18.6% vs. 16.1%, p\u0026thinsp;=\u0026thinsp;0.75).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eDespite longer operative times, cTHA demonstrated similar LOS, complication rates, and 90-day unplanned readmissions compared to pTHA for FNF. These findings suggest that, when appropriately indicated and performed in experienced centers, cTHA is a safe salvage option following failed osteosynthesis. Nevertheless, meticulous preoperative planning remains essential due to the increased complexity of conversion procedures.\u003c/p\u003e","manuscriptTitle":"Comparative Results between Conversion to Total Hip Arthroplasty Secondary to Failed Osteosynthesis versus Total Hip Arthroplasty after Femoral Neck Fracture","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 12:27:07","doi":"10.21203/rs.3.rs-8129783/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"06329cf9-fea7-4f89-8892-776b4b2aad7e","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-11T16:53:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 12:27:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8129783","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8129783","identity":"rs-8129783","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}